Or. Admin. R. 111-050-0050 - Removing an Ineligible Individual from Benefit Plans
(1) An Eligible Early Retiree who enrolls
themselves and/or an eligible person is responsible for removing ineligible
spouses, domestic partners and children from their OEBB-sponsored benefit plans
by submitting completed, applicable forms to their Entity benefits
administrator within 31 calendar days after the date the individual becomes
ineligible. Coverage ends on the date identified under OAR
111-050-0045.
(2) An Entity is
responsible for removing ineligible individuals from the OEBB benefits
management system. The Entity must complete such removal within 14 calendar
days after:
(a) An event resulting in loss of
the Early Retiree's eligibility, or
(b) The receipt of notification of an event
resulting in loss of eligibility of the Early Retiree's spouse, domestic
partner or child.
(3) If
coverage of an Early Retiree's spouse, domestic partner or child is terminated
retroactively then:
(a) The Early Retiree may
be responsible for claims previously paid by the benefit plans to the providers
during the period of ineligibility at the carrier's discretion; and
(b) Premium adjustments will be made
retroactively based on the coverage end date.
(4) OEBB shall conduct eligibility
verifications and reviews to monitor compliance with OEBB administrative rules
governing eligibility and enrollment. Eligibility reviews may occur at
different times throughout the plan year. The member is responsible to submit
documentation upon request. In the event the member does not provide the
required documentation in a timely manner to sufficiently prove the dependent
meets eligibility requirements, or the documentation provided is insufficient,
the dependent's coverage will be terminated. Retroactive terminations may occur
if the documentation provided shows the dependent was not eligible for coverage
and the member misrepresented the dependent as being an eligible dependent as
defined by OAR 111-080-0045.
(3)
OEBB long term care carrier(s) will transfer the coverage from a Group Long
Term Care to an Individual Long Term Care policy and premiums will be paid
directly to the carrier upon request.
Notes
Statutory/Other Authority: ORS 243.860 - 243.886
Statutes/Other Implemented: ORS 243.864(1)(a)
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